ARE THERE MISSED OPPORTUNITIES WITHIN HEALTH AND  SOCIAL CARE PRACTICE THAT COULD PREVENT HOMELESSNESS?Ruth Elias Jones

Research questions  Background  Methods  Results  Implications for interprofessional care

AIM

To identify the precipitating factors to becoming homeless and in particular missed contact opportunities by health and social care practitioners and members of the voluntary sector. 

RESEARCH QUESTIONS

How and with whom (members of the public services) do homeless people have contact with prior to becoming homeless? 

Which members of the public sector would homeless people most likely seek help and support from prior to becoming homeless? 

How might people access better support to prevent homelessness? 

Is there a common list of factors which should alert public sector workers to protect individuals from homelessness? 

What are the messages for the caring professions?

BACKGROUND

Homelessness is increasing Strongly associated with poor physical and

mental health Little access to healthcare and other services

Stigma and staff attitudes Mistrust of professionals and institutions Experiences of bad treatment and being let down

RISK FACTORSSocial factors Family background

and childhoodHealth factors Institutional

backgroundSocial isolation

Unemployment

Poverty

Debt and mortgage/ rent arrears

Eastern and Central European migrants

Asylum seekers

Physical, sexual or mental abuse or neglect

Parents with drug or alcohol problems

Family history of homelessness

Involvement in crime at an early age

Exclusion from school and lack of qualifications

Family breakdown

Poor physical health

Mental illness

Addiction and substance abuse

HM forces

Care

Prison

Hospital/psychiatric care

CHILDHOOD RISK FACTORSExperiences in childhood (under 16 years old)

Truanted from school a lot

Didn’t get along with parent(s)/step-parent/carer(s)

Suspended, excluded or expelled from school at least once

Ran away from home and stayed away for at least one night

Violence between parents/carers

Parent(s)/step-parent/carer(s) had a drug or alcohol problem

Badly bullied by other children

Physically abused at home

Brought up in workless household

Family was homeless

Spent time in local authority care

Sexually abused

There was sometimes not enough to eat at home

Neglected

Parent(s)/step-parent/carer(s) had a mental health problem

METHODS

Ethical permission granted Recruitment from Action Homeless hostels

Male Currently homeless Resident of an Action Homeless property Willing and able to be interviewed – no physical

or mental barriers to interview Conduction of semi structured interviews  Transcription into MS Word  Thematic analysis using NVivo

RESULTS

DESCRIPTION OF THE SAMPLE

12 interviews included  Aged 20-55  Homeless for between 3 months and 33

years

2

1

2

3

2

1

1

Participants' basic level of qualification

UniversityA LevelsHigh level vocational train-ingLow level vocational train-ingMaths or English below en-try level 3Maths or English below en-try level 2Illiterate

CAUSES OF HOMELESSNESS

Long term  Medium term  Short termLON

G TERM

Abuse

MEDIUM

TERMMenta

l illnessAddict

ion

SHORT

TERMRelationshi

p breakdown

ABUSE

“I was taking drugs from the age of nine years old, I was drinking at the age of 10.

And obviously depressed and had mental issues and my past issues [his abuse], I just couldn't cope with, so I took anything and anything to numb it

out”

ABUSE

“I was like being seriously hurt and that, when I was younger… That’s why I wasn’t seeing it as bad… I was thinking this is nothing compared to what’s happened, it’s nothing… I didn’t feel I was being threatened or it

was abuse of any type…

The way I was seeing it was the way I was raised up, well I’ve done something naughty,

I needed to be punished”

MEDICAL MISMANAGEMENT

“I had a really severe panic attack… The doctors put me on Valium and then in the evenings I used to have 2 or 3 pints, just to steady me nerves. In a sense, that’s, I think, where it began… I became self-medicating with alcohol”

“Well I wasn't sleeping properly so they gave me sleeping tablets and depression, they said you're depressed, that's why you’re gambling…”

“But doctors weren’t really especially interested… Some of them are very averse to helping people who have drug or alcohol issues. Some are sympathetic but there are quite a few who really just think you’re a waste of time.”

NOT ADDRESSING UNDERLYING SOCIAL PROBLEMS

“No you’re medically fit, you, there’s nothing wrong with your bloods, you can go”

“But there were nothing from the GP to point me in the right direction for the advice and the help that I needed… I told him exactly how I felt, what was going on in my life and it was just ‘well its just a quick appointment, yeah I’ll give you these 20mg tablets that’s not really going to do anything’”

LACK OF FOLLOW UP AND ONGOING SUPPORT

“If they had continued my support on my release then maybe things would’ve been different”

“We didn't hear any like ongoing support, we didn't get any phone calls… they thought everything was all right, you know what I mean, but then about 6, 7 months later my sister has been kicked out”

NOT RECOGNISING RISK FACTORS

“I was a bit of a tearaway… rebellious, angry, I didn't really care about anything… that's why I’ve ended up in and out of prison all my life”

“I feel that when I was a kid my needs weren't addressed properly because you know, I'd been expelled from two different schools”

DISCUSSION

MESSAGES FOR THE CARING PROFESSIONS

Greater awareness of homelessness and its causes

Education and training on the risk factors Training and information about local

resources to enable signposting Improved communication within and

between professions Proactive stance to preventing homelessness

MESSAGES FOR THE CARING PROFESSIONS

We may be the only contact a person has with services

We all have a role in identifying those at risk of homelessness

It is our responsibility to work together

Preventing homelessness may be as simple as doing our jobs correctly

“For many people, becoming homeless is not the beginning of their problems; it comes at the end

of a long line of crises, a long line of interactions with public and voluntary sector services, a long line of missed opportunities.

We must change that.”

The Rt Hon Grant Shapps MP, Minister for Housing, 2012